I'm probably not the best one to be answering this, because I tend to be rather blunt, but no one else has replied, and I too have had these issues with family. However, I don't usually say it with a smile. I just say the issue straight and to the point. "Just the facts, ma'am." However, I have never (knocking on wood) had someone complain that I was rude. "She is receiving *whatever treatment* for *whatever reason* and per *whatever MD's* orders. I would be happy to pass the concern over to the MD during rounds." Sometimes I will ask directly "What is it that you are concerned about *this treatment*?" and if it's something I can answer I do so, or find the information to help them. And if the patient voices the refusal to me directly, I will remove *whatever is offending them* and document. Patients are allowed to refuse treatment, and I always state this. But until the patient tells me they don't want it, or it's not safe, or the MD orders it DCd, I am to continue *the treatment*, unless that family member is medical POA and the patient is unable to voice their wishes. The ones who puff up and state they are *whatever medical profession* will understand your need to document about patient's refusing treatment, unless they are not actually that profession. Which has happened more often than I care to comment.
A simple example: A patient had come to us from a stay in ICU with a peripheral still intact and within date. The peripheral was not needed for current treatment, all medications were po, but still flushed well and after a day even still had blood return. A family member asked why the pt still had "that IV" and why didn't I remove it after I had checked it's viability. I said I would check if we needed it, but that it was still a good IV. I checked with the MD (he happened to be at the desk) and asked how he felt about me removing the peripheral. He told me and I explained (speaking both to the fully alert and oriented pt and the family member) that while the patient was better and no longer needed the higher level of care that the ICU offered, the pt was still medically fragile, and if an emergency happened, starting an IV would take needed time and definitely an additional hole, if not more since she was a difficult stick. (Actually what the MD answered was "if she crashes again, how fast could you start an IV on her?" I didn't state it in quite those terms to the pt.) "This is a good IV, still within date. Until it's no longer viable, it's safer to keep it intact." The patient understood, and once the pt understood, I no longer needed to discuss the matter w/ the family.